2013   Programme Application   


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I. PERSONAL INFORMATION

This information is for your visa. Use the details from your international passport.

Country of your interview:   #

First Name:   #
Middle Name:    
Last Name:   #
Other Names:    
Gender: 
 Male        Female
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Date of Birth: 
   
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City of Birth:   #
Country of Birth:  #
Country of Citizenship:  #
Country of Legal Permanent Residence:  #
Street/Apartment:   #
Town/City:   #
Post/City Code:   #
Country:  #
Phone Number:    
Mobile Number:    
Email:    
Height (ft/in):   #
Weight (lbs):   #
Marriage Status: 
 Married        Unmarried
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Driver License: 
 Yes        No
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Smoker: 
 Yes        No
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Emergency Contact:   Name:  
Relationship:  
Phone (include country codes):  
Work Phone (include country codes):  
Mobile Phone (include country codes):  
Email:  
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II. EDUCATION
Are you currently a full-time student?: 
 Yes        No
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Will you be a full-time student in October 2013?: 
 Yes        No
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If Yes   List year of study:  
Name of College:  
Length of course/study years:  
Name of Faculty:  
Department:  
Others:  
 
III. EMPLOYMENT
Are you employed in your home country?:        Yes        No
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If Yes  
 Full-time        Part-time        Voluntary
Current employment:  
If No   Previous employment:  
 
Note: If you are not employed full-time or a full-time student you must provide evidence of reason to return in order to apply for the J-1 visa.  
Preference for a specific U.S. employer (only to be completed by those without a verifiable job offer at time of application - SWT Self-Arranged Job Option only):  
Company name:    
Hiring manager's name:    
Phone:    
Fax:    
E-mail:    
Have you participated in an exchange programme in the past?:        Yes        No
 
If Yes   Agency/sponsor:  
Year(s):  
Recent employer in the U.S.:  
Contact name:  
Phone:  
 
IV. SKILLS - COUNSELLOR APPLICANTS ONLY
Complete this section ONLY if you are applying for a Specialized Camp Counsellor position.  
Please complete the following chart, indicating your highest level of camp activity qualification and experience:  
My best camp activities and/or skills are: I am certified to teach or coach: Year of certification I could teach or coach: I could assist: Copy of award enclosed?
 Yes    No
 Yes    No
 Yes    No
 Yes    No
 Yes    No
 Yes    No
 Yes    No
 Yes    No
 Yes    No
 Yes    No
 Yes    No
 Yes    No
 
(Note: The inclusion of any sport/activity in this list doeas not imply that you will be hired to teach/coach that activity on camp. However, if you do hold a teaching or coaching qualification that is internationally recognized, you should contact your Camp Director to discuss your position responsibilities and if you are eligible to receive the Qualified Status Bonus of up to $500).  
Please detail your experiences in the skills listed above (When and where you gained your experience and the ages of people taught/coached):  
 
Please provide details (including dates) of your experience with children (e.g. youth clubs, community programmes, play schemes, etc.) and include any leadership roles and ages of children you have worked with:  
 
With which age group do you have the most experience?:        under 5yrs        6-10yrs        11-14yrs        15+yrs
 
Please list any unique skills you may have (cirkus skills, story-telling, face painting, etc.):  
 
Do you have a swimming, life-guard or life-saving award?:        Yes        No
 
If yes, please list below any awards that were gained after the age of 16:  
Certificate/Award Date Issued Expiry Date Level/Grade Copy Enclosed?
 Yes    No
 Yes    No
Note: To be considered for a waterfront position, certificates/awards must be current and you must have provide proof of certification prior to arriving at your camp.  
If you are applying for a Special Needs Counsellor position, please complete the section below in addition to the section above:  
Do you have experience working with people with disabilities?:        Yes        No
 
Would you consider working at a camp for mentally and/or physically challenged adults and or teenagers?:        Yes        No
 
AWE works with selected high-quality Special Needs camps. There is a large demand for staff at these camps and whilst some camps require previous experience, others will determine your suitability from the information you supply and possibly an additional interview. As a special needs counsellor, your duties would include caring for the guest's personal (children and/or adults) needs (feeding, bathing and toileting), in addition to assistance with sports and other camp activities. If you are willing to work on a Special Needs camp, please use the space below to tell us why you would be suited to such work, detailing any previous experience working specifically with people with special needs. (Note: AWE will not place you on a Special Needs camp without your consent.)  
 
V. SKILLS - SWT AND CAMP SUPPORT APPLICANTS ONLY
Complete this section ONLY if you are applying for a Summer Work Travel or Camp Support Staff position.  
Please tick the position below in which you have experience (E) and those in which you are willing (W) to work.  
   E  W      E  W
Cook   Guest Services
Assistant Cook   Cash Handling
Food Preparation   Secretarial/Office
Waiter/Waitress   Security
Dishwashing   Auto Mechanics
Maintenance   Driver
Painting   Theme Park Worker
Landscaping   Children's Host
Cabin/Room Cleaning   Shop Assistant
Janitorial   Pool Cleaner
Laundry   Life Guard
Reception Duties  
Other  
Adaptability and flexibility are important qualities employers seek. Are you willing to work in any area?:        Yes        No
 
If No, in which areas are you not willing to work?:    
Please list previous employment below, starting with your most recent job:  
Type of employment (part/full-time, paid/unpaid) Dates of employment Position/job title Main activities and/or duties Reference Enclosed?
 Yes    No
 Yes    No
 Yes    No
 Yes    No
Note: All SWT and Support Staff applicants must have previous full or part-time work experience, either paid or voluntary. Employment must have lasted for more than two weeks.  
Do you have a swimming, life-guard or life-saving award?:        Yes        No
 
If yes, please list below any awards that were gained after the age of 16:  
Certificate/Award Date Issued Expiry Date Level/Grade Copy Enclosed?
 Yes    No
 Yes    No
Note: To be considered for a waterfront position, certificates/awards must be current and you must have provide proof of certification prior to arriving at your job.  
Please use the space below to describe your experience in those areas ticked above that you feel you are most qualified. Indicate any relevant duties performed and why you feel these particular areas are strongest.  
 
Employers seek staff that have an adaptable, flexible and enthusiastic attitude toward the prospect of joining their teams. Using the space below, describe what you feel to be your strongest qualities in a work environment.  
 
Please list any additional skills or experience you have.  
 
VI. FAMILY BACKGROUND
This will improve your chances of the US Embassy granting your visa.  
Can you show strong economic/social ties to your country?:        Yes        No
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Please explain:    
Do you have relatives/friends in the U.S.?:        Yes        No
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If Yes, provide details:   Name:  
Relationship:  
Address:  
Phone:  
 
Please describe your family background (number of members in your family background (number of members in your family, etc.) and any special interests you may have:  
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Have you ever traveled outside your own country?:        Yes        No
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If Yes:   State countries visited, reason and length of stay:
 
VII. SPECIAL PLACEMENT REQUIREMENTS
Whilst we will try to accommodate your requests, no guarantee is given.  
Do you have a friend/partner also making an application to AWE with whom you would like to be placed?:        Yes        No
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If Yes, provide details:   First name:  
Last name:  
Country:  
AWE ID (if known):  
 
If AWE is unable to place you together, would you still like to be considered for placement?:        Yes        No
 
Please provide details of any special assistance you may required during placement (e.g. disabilities, special eating requirements):  
 
By coming to the U.S. you will be exposed to new situations such as homesickness, curfews, restrictions on drinking and smoking, and strict adherence to rules and regulations. How do you feel you would react to these situations?:  
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VIII. MEDICAL INFORMATION
All participants are required to be in good physical/mental health and undergo a physical examination before departure to the U.S. A copy of the medical report validated by the doctor must be provided.  
Please indicate below if you suffer or have ever suffered from any of the following conditions:
(Note: If you answer YES to any of these questions, you may need to obtain additional insurance, as AWE insurance does not cover pre-existing conditions.) 		#
  Yes  No     Yes  No
Allergies to food   Epilepsy
Allergies to medicine   Dietary restrictions
Allergies to insect bites   Eating disorder
Other Allergies   Mental illness/breakdown
Physical disability   Depression
Diabetes  
Other  
 
Have you ever been the victim of sexual abuse?:        Yes        No
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If you answered yes to any of the above questions or if there is any other important medical information that AWE should be aware of that was not indicated above, please comment:  
 
IX. CONFIDENTIAL BACKGROUND CHECK
AWE requires that you complete the following questions honestly: #
  Yes  No
Have you ever been the subject of:   a Caution of Bound over Order?  
an arrest?  
Have you ever been convicted of any:   violent offence/crime?  
drug/related offence/crime?  
sexual offence/crime?  
Are you awaiting notification of any:   court judgment?  
police action against you?  
Do you object to AWE conducting a background check on you?  
 
Note: If you answered Yes to any of the above questions, you must provide details including dates and judgments. Attach an additional sheet of paper.  
The background check for UK APPLICANTS ONLY, is regarding your suitability for working with children. You are advised that under the provisions of the Rehabilitation of Offenders Act 1974 (Exceptions) order 1975, as amended by the Rehabilitations of Offenders Act 1974 (Exceptions) (Amendments) Order 1986, you should declare all convictions including "spent" convictions. Data Protection Act-You should be aware that your personal details will be stored in electronic format.  
X. PARTICIPANT AGREEMENT
I have read, understood and agree to abide by the conditions of application and placement as detailed in the American Work Experience (AWE) 2013 Terms and Conditions, which are part of the 2013 AWE Application Brochure which I have received and have read. By signing the programme Application I have agreed to the complete contents of the AWE 2013 Terms and Conditions. My attention has been drawn to clause 57 from the aforementioned Terms and Conditions. I have completed this form fully and honestly and agree to return to my Home Country at the conclusion of my Placement and inform AWE of my return to my Home country. #

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